USACHPPM HEALTH INFORMATION OPERATIONS (HIO) UPDATE 12 September 2003

The HIO Update provides information regarding global medical and veterinary issues of interest to the United States (US) Army. The update does not attempt to analyze the information regarding potential strategic or tactical impact to the US Army and as such, should not be regarded as a medical intelligence product. Medical intelligence products are available at http://mic.afmic.detrick.army.mil/. The information in the HIO Update should provide an increased awareness of current and emerging health-related issues.

HOT TOPICS................................................................................................ 2
Accuracy of Screening for Inhalational Anthrax after a Bioterrorist Attack ......................................... 2 Belly Bug Could Treat Diabetes ................................................................................................................ 2 Biological Weapons a “Priority” for Osama bin Laden ........................................................................... 2 Exercise Testing Predicts Heart Death .................................................................................................... 3 Exotic Market Yields SARS Clue............................................................................................................... 3 More Mental Disorders in Canadian Military............................................................................................ 3 New Blood Test Uncovers Individual Risk For Lung Cancer ................................................................ 3 New Tools Help Families and Schools Prepare for Disasters .............................................................. 3 Researchers to Hand Out SARS Test Kits .............................................................................................. 4 Severe Acute Respiratory Syndrome–associated Coronavirus in Lung Tissue ................................ 4 Study Shows Protein Injection Sharply Cuts Appetite ........................................................................... 4 Sweet Treatment Cuts Heart Attack Deaths............................................................................................ 4 WHO Advocates Flu Shots to Limit SARS False Alarms ...................................................................... 5 WHO Warns of Resurgence of SARS, Other Diseases ........................................................................ 5

USEUCOM.................................................................................................... 5
Ambulance Bugs 'Endanger Patients' ...................................................................................................... 5 Outbreak of Salmonella bareilly in the United Kingdom: update.......................................................... 5 WHO Warns Liberian Health Situation Quickly Deteriorating ............................................................... 5

USCENTCOM............................................................................................... 6
Afghanistan: Mysterious Disease Claims 11 Lives in Spin Boldak ...................................................... 6 High Prevalence of Leishmaniasis in Afghanistan.................................................................................. 6 Pakistan: New Study Shows Half the Population Lacks Safe Water................................................... 6 Tajikistan: Residents in the Tajik Capital Confront Typhoid Outbreak ................................................ 6

USNORTHCOM ........................................................................................... 7
Approval for Extended Oral Contraceptive .............................................................................................. 7 Delaware: Legionnaires' Disease Cases Reach 22 in Delaware ......................................................... 7 Emergency Room Requirements Tweaked............................................................................................. 7 HHS Announces New Regional Centers for Biodefense Research..................................................... 7 National Cholesterol Education Month ..................................................................................................... 8 Officials Discover Leaking Mustard Gas at Deseret Chemical Depot ................................................. 8 Pace of West Nile Cases Slows, But Deaths Rise ................................................................................. 8 Project Bioshield Could Allow Withholding Drug Information From Military Personnel .................... 8 Serious Pneumonia Source Found in 4 U.S. Troops ............................................................................. 8 Survey Finds Millions of New U.S. Drug Abusers .................................................................................. 9 US to Miss Key Deadline for Chemical Weapons Destruction ............................................................. 9 Va. Reports La Crosse Encephalitis Cases............................................................................................. 9 West Nile Virus in the U.S. as of 9 September, 2003 .......................................................................... 10

USPACOM.................................................................................................. 10
Bhutan: Conjunctivitis Outbreak in Phuentsholing................................................................................ 10 China Starts SARS Surveillance Program Before Flu Season Starts ............................................... 10 Dengue and Other Mosquito-Borne Diseases Continue to Plague Asia........................................... 11 Eight Die after Eating Poisoned Rice in China, 400 Others Poisoned .............................................. 11 Hong Kong: DH Confirms New Cases of Cholera ................................................................................ 11 Singapore: Patient at SGH Tests Positive for SARS Virus ................................................................. 11 Taiwan - First Local Transmission of Malaria in 38 Years .................................................................. 12 Typhoon Dujuan leaves at least 32 dead, five missing in South China ............................................ 12 WHO Intensifies Efforts to Eradicate Polio ............................................................................................ 12

USSOUTHCOM ......................................................................................... 12
Bermuda Cleans Up after Strongest Hurricane in 50 Years ............................................................... 12 Venezuela - Yellow fever.......................................................................................................................... 13

HOT TOPICS
Accuracy of Screening for Inhalational Anthrax after a Bioterrorist Attack
02 September – The Annals of Internal Medicine published a study regarding mass screening to identify early inhalational anthrax in effort to improve both management of individual cases and efficiency of health resource utilization. The study concluded inhalational anthrax has characteristic clinical features that are distinct from those seen in common viral respiratory tract infections. Screening protocols based on these features may improve rapid identification of patients with presumptive inhalational anthrax in the setting of a large-scale anthrax attack. View Article

Belly Bug Could Treat Diabetes
05 September – BBC News reported bugs that cause stomach upsets in travelers are leading scientists to a vaccine for diabetes and arthritis. UK researchers will soon start human trials of a drug derived from the toxin of a bacterium that causes diarrhea in globe trotters. It has already been tested in mice successfully, reducing the incidence of illness in model rodents from 80% to about 15%. The team is using just a transport component of the bacterium's toxin molecule. Called ETxB, the component is separated off from the rest of the protein so there is no chance of a vaccine causing stomach upsets in patients. Scientists have discovered that ETxB on its own is sufficient to stimulate so-called T regulatory cells, which in healthy patients act to suppress auto-immune diseases. The Bristol group hope that by giving an ETxB vaccine to patients recently diagnosed with rheumatoid arthritis and type 1 diabetes they can significantly slow the progression of the diseases. View Article

Biological Weapons a “Priority” for Osama bin Laden
04 September – Global Security News reported a ranking Taliban source has said that terrorist mastermind Osama bin Laden has made the use of biological weapons in a future terrorist attack a “priority,” Newsweek reported. In April, bin Laden held a meeting in Afghanistan that included representatives from the Taliban, senior al-Qaeda operatives and leaders from Islamic militant groups based in the disputed Russian region of Chechnya and Uzbekistan, according to a former Taliban deputy foreign minister. During the meeting, bin Laden said he was working on “serious projects,” including attacks with biological weapons, a ranking Taliban source said. Al-Qaeda currently

possesses biological weapons, the source said, adding that only transportation and launch problems remain to be solved. View Article

Exercise Testing Predicts Heart Death
04 September – Health Day News reported exercise testing not only helps predict a person's risk of death, but it can also help rule out those who don't require aggressive treatment for cardiovascular disease, a study says. The stress test is a good gauge independent of another test, angiography, which looks for diseased arteries, the study says. Scientists collected data on 2,935 patients suspected of having heart disease. The patients underwent exercise testing followed by an angiogram. The results appear in the current issue of the Journal of the American College of Cardiology. View Article

Exotic Market Yields SARS Clue
04 September – Health Day News reported swabs from two Himalayan palm civets, members of a cat-like family, turned up a coronavirus resembling one that is carried by many humans but does no harm, scientists at the University of Hong Kong report in the Sept. 5 issue of Science. The virus was also found in a raccoon-dog and a ferret badger from the same market, and in some employees at the market. Although the workers showed no signs of illness, the discovery "indicates a route of interspecies transmission" that created the severe acute respiratory syndrome virus, the report says. View Article

More Mental Disorders in Canadian Military
06 September – The Halifax Herald Limited reported Canadian soldiers, sailors and air personnel are more likely to report symptoms of major depression and panic disorder than members of the general population, a landmark study of mental health in the military said. Curiously, though, the survey found that the incidence of post-traumatic stress disorder is no higher among the military than in the general population. Nor was the reported incidence of alcoholism. Overall, about 15 per cent of regulars reported symptoms of at least one of five mental disorders or dependence on alcohol or drugs. About 12.7 per cent of military reservists reported problems. A similar survey of Canadians as a whole saw about 10 per cent reporting such symptoms. The military study was conducted by Statistics Canada between May and December last year. The study also found a relationship between the number of times a soldier was deployed on overseas operations and the prevalence of post-traumatic stress disorder. View Report

New Blood Test Uncovers Individual Risk For Lung Cancer
04 September – Science Daily reported scientists at the Weizmann Institute have discovered a new genetic risk factor that increases the susceptibility of smokers to lung cancer. Published in the Journal of the National Cancer Institute, the findings show that smokers who carry the newly discovered genetic marker are around 120 times more likely to get lung cancer than non-smokers who do not have the risk factor. A simple blood test based on these findings will be able to detect smokers who are at especially high risk of developing lung cancer. View Article

New Tools Help Families and Schools Prepare for Disasters
03 September – Eurekalert reported as the second anniversary of the Sept. 11, 2001, attacks on America nears, the National Child Traumatic Stress Network (NCTSN) is disseminating two new tools to help families and schools prepare for future disasters and terrorism. This nationwide school

preparedness initiative is endorsed by the U.S. Department of Education. The tools will help those who care for children assess and address various aspects of disaster planning, including safety, security and well-being. View Article Checklist for Schools Family Preparedness Plan

Researchers to Hand Out SARS Test Kits
05 September – ABC News reported two Singapore labs said they have jointly developed a simple-touse 15-minute SARS test kit that could potentially help prevent the spread of the virus in poor and remote areas. Officials from Genelabs Diagnostics and the government-funded Institute of Molecular and Cell Biology told a press conference that the test is 99 percent accurate in detecting SARS in patients who have been sick for 16 days or more. It works by detecting SARS antibodies in serum or plasma, said Noel Ho, spokesman for Genelabs. Ho said the Genelabs test, because it requires no special equipment and minimal training to use, would be ideal for managing outbreaks in remote areas and developing countries. View Article

Severe Acute Respiratory Syndrome–associated Coronavirus in Lung Tissue
01 September – The Journal of Emerging Infectious Diseases published an expedited article in the current online issue of the journal. Efforts to contain severe acute respiratory syndrome (SARS) have been limited by the lack of a standardized, sensitive, and specific test for SARS-associated coronavirus (CoV). Authors used a standardized reverse transcription-polymerase chain reaction assay to detect SARS-CoV in lung samples obtained from well-characterized patients who died of SARS and from those who died of other reasons. SARS-CoV was detected in all 22 postmortem lung tissues from 11 patients with probable SARS but was not detected in any of the 23 lung control samples. The sensitivity and specificity were 100% and 100% respectively. Viral loads were significantly associated with a shorter course of illness but not with the use of ribavirin or steroids. CoV was consistently identified in the lungs of all patients who died of SARS but not in control patients, supporting a primary role for CoV in deaths. View Article

Study Shows Protein Injection Sharply Cuts Appetite
03 September – Reuters reported a protein found naturally in the body could bring scientists a step closer to developing a natural and effective diet pill, according to a new British study. Volunteers injected with the protein PYY two hours before mealtime consumed 30 percent fewer calories when they sat down to eat, without experiencing any difference in the taste of the food or other apparent side effects. Injections of PYY two hours before mealtime cut the appetite of fat and skinny people, and did so without affecting the taste of the food or causing other apparent side effects. View Article

Sweet Treatment Cuts Heart Attack Deaths
02 September – Health Day News reported giving heart cells a healthy dose of sugar in the first hours after a heart attack significantly improves the chance of survival for most patients, says a Dutch study. Infusion of a solution combining glucose, insulin and potassium decreased the death rate by nearly three-quarters for heart attack patients who did not also have heart failure. The article is published in the 03 September issue of the Journal of the American College of Cardiology. In the Dutch study, only 1.2 percent of the heart attack patients without heart failure who were given the infusion died, compared to 4.2 percent of those who did not get the reduction -- a 72 percent decrease. View Article

WHO Advocates Flu Shots to Limit SARS False Alarms
03 September – CIDRAP News reported the World Health Organization (WHO) says influenza vaccination may yield an extra benefit this year: limiting the number of false alarms for SARS (severe acute respiratory syndrome). In a statement, WHO officials recommended influenza shots for those susceptible to serious influenza complications, including pneumonia, and for health workers who care for them. Vulnerable groups include the elderly, immunocompromized people, and those with chronic cardiopulmonary, kidney, or metabolic diseases. View Article

WHO Warns of Resurgence of SARS, Other Diseases
08 September – Reuters reported the head of the World Health Organization warned health specialists of a possible resurgence of the deadly SARS virus and urged countries to boost surveillance. "None of us can predict what will happen later this year. Will SARS come back or not?" Director-General Lee Jong-wook told a WHO regional committee meeting in Manila. "We have to prepare on the assumption that this will come back. Our challenge now is to enhance surveillance networks that will detect and deal with SARS if it does come back," Lee said. Severe Acute Respiratory Syndrome killed more than 800 people after it apparently jumped to humans from animals in southern China late last year and was then spread worldwide by travelers. View Article

USEUCOM
Ambulance Bugs 'Endanger Patients'
03 September – BBC News reported inadequate cleaning of ambulances could be putting the health of patients at risk, say researchers. A study of Welsh ambulances found many were contaminated with bacteria that could cause serious infections in vulnerable patients. The authors, from the University of Wales, said there was nothing to suggest ambulances in the rest of the UK were any better. They said rules for ensuring cleanliness of vehicles were inadequate. The study is published in the Emergency Medicine Journal. View Article

Outbreak of Salmonella bareilly in the United Kingdom: update
07 September – ProMed reported the cumulative total of cases of Salmonella bareilly in England and Wales since 1 Aug 2003, confirmed by England and Wales' Health Protection Agency Laboratory of Enteric Pathogens (LEP), has risen to 108 (1, 2). There are also 23 cases in Scotland. The epidemic curve is consistent with a continuing source, and the last known date of onset is now 23 Aug 2003. Following hypothesis-generating interviews, a national case control study began on 30 Aug 2003. Medical microbiologists in England and Wales have been asked to ensure that Group C1 Salmonellas (O6,7:y:1,5) are referred for confirmation and typing as quickly as possible. View Report

WHO Warns Liberian Health Situation Quickly Deteriorating
04 September – VOA News reported West African peacekeepers are heading north of Liberia's capital to investigate reports of fighting that is driving thousands of civilians from their homes. In the meantime, World Health Organization delegates in Monrovia are warning of a major health crisis there, including an outbreak of cholera. Hundreds of thousands of Liberians fled last month's fighting and flooded the capital, Monrovia. Few have left. WHO spokeswoman Melanie Zipperer says more than 25,000 displaced persons have been squeezed into 90 camps in and around the capital. More

than 45,000 are crowded into the city's football stadium. Ms. Zipperer says the health situation is deteriorating rapidly. In a phone interview from Monrovia, she reports the spread of cholera, dysentery and skin infections from the crowded conditions and inadequate sanitary and health facilities. View Article

USCENTCOM
Afghanistan: Mysterious Disease Claims 11 Lives in Spin Boldak
08 September – ProMed reported 11 persons have been killed owing to the eruption of a mysterious disease in the village of Loya Karez at Spin Boldak. Dr Muhammad Ibrahim of the government hospital stated that the sudden outbreak of the mysterious disease has played havoc leading to 11 deaths in the areas of Kulli Halqa, Beecha and Malavi Lakai. The age range of the victims is between 30 to 40 years, he added. Doctor Ibrahim stated that all the steps have been taken to control the disease saying that it has been caused by contaminated water. View Report

High Prevalence of Leishmaniasis in Afghanistan
09 September – ProMed reported the Dutch non-governmental organization HealthNet International (HNI) has carried out a cutaneous leishmaniasis (CL) prevalence survey in the city of Faizabad, Badakshan province, Afghanistan, which showed that 8.3 percent of surveyed people had CL lesions. Based on Faizabad population estimates of 65,000 people and observed CL prevalence, it is estimated that there are approximately 5400 CL cases in Faizabad. It was also shown that 7.8 percent of surveyed people had CL scars. The low prevalence of CL scars, compared with the high prevalence of disease, shows that CL has been introduced into Faizabad only recently. Records by the local Ministry of Health show that the disease was virtually unknown in Badakshan in 2000. Though no attempts were made to identify the species of circulating Leishmania, it appears the current epidemic is due to L. tropica, because of the clustering of cases and because both sexes are equally affected. In Afghanistan, the majority of CL cases are caused by L. tropica, which is transmitted anthroponoticically by the sandfly Phlebotomus sergenti. View Report

Pakistan: New Study Shows Half the Population Lacks Safe Water
28 August – IRIN News reported only 56 percent of the total population of Pakistan has access to safe drinking water, according to a study, entitled "Water, A Vital Source of Life", published by the United Nations System in Pakistan, and launched in the capital, Islamabad. "This is a significant contribution towards mass awareness programs in the area of water management. The articles regarding provincial water situations give deep insight into the local issues," Maj (retd) Tahir Iqbal, the environment minister, said at the launch. The book is the result of a collaborative effort, with journalists, federal ministers, and school children all having contributed. It also includes recommendations by UN agencies in Pakistan on improving water management. View Article

Tajikistan: Residents in the Tajik Capital Confront Typhoid Outbreak
08 September – ProMed reported at least 500 people have contracted typhoid in Dushanbe, according to media reports, with 3 reported fatalities. 1700 medical personnel are working to protect the population of Dushanbe from the disease. Health officials said the outbreak likely began in the Bokhtar district 2 months ago, with contaminated water the suspected cause. View Report

USNORTHCOM
Approval for Extended Oral Contraceptive
05 September – Reuters reported Barr Laboratories Inc. won U.S. regulatory clearance to market the first birth control pill designed to cut the number of a woman's menstrual cycles to four a year from 13. The company said the extended-cycle pill, called Seasonale, will be available by prescription at the end of October. Women will take Seasonale tablets for up to 84 consecutive days, followed by a seven-day placebo interval. Most oral contraceptives currently sold in the United States are based on a regimen of 21 treatment days followed by seven days of placebo. View Article

Delaware: Legionnaires' Disease Cases Reach 22 in Delaware
04 September – ProMed reported the total number of Legionnaires’ disease cases in Delaware has reached 22 so far in 2003, state health officials said. The Delaware Department of Public Health (DPH) has been tracking a rise in the number of Legionnaires’ disease cases since the beginning of 2003. On average, between 1995 and 2002, the state saw only 14 cases. Of the 22 so far, 14 of those infected have been Sussex County residents. According to the DPH, the patients' ages ranged from 35 to 81 years. They worked at a variety of occupations and so far displayed no signs of being infected from any common sources. All but 3 of the patients were known to have risk factors associated with being infected with Legionnaires' disease: smoking, chronic lung disease, compromised immune systems, kidney problems, or diabetes. The increase in Delaware's Legionnaires’ disease cases reflects a rise in occurrence of the disease throughout the region. As of 17 Aug 2003, the states of Virginia, Maryland, Delaware, North Carolina, South Carolina, Georgia, Florida, and Washington DC have seen a total of 304 cases. Those same areas saw a total of 117 reported by this time in 2002. View Report

Emergency Room Requirements Tweaked
03 September – Reuters reported the Bush administration said it was easing rules that require hospitals to provide emergency care to anyone who seeks it, making it easier for emergency rooms to turn away some patients. The revisions, supported by the hospital industry, are meant to clarify a hospital's liability for treating emergency patients, the U.S. Health and Human Services Department said. Supporters say they will help ease overcrowding in emergency rooms, while at least one consumer group expressed fears that the changes will leave more poor and uninsured patients out in the cold. The changes, which take effect in November and require no congressional approval, affect the 1986 Emergency Medical Treatment and Labor Act. View Article

HHS Announces New Regional Centers for Biodefense Research
04 September – Eurekalert reported Health and Human Services Secretary Tommy G. Thompson today announced grants totaling approximately $350 million spread over five years to establish eight Regional Centers of Excellence for Biodefense and Emerging Infectious Diseases Research (RCE). This nationwide group of multidisciplinary centers is a key element in HHS' strategic plan for biodefense research. "We have moved with unprecedented speed and determination to prepare for a bioterror attack or any other public health crisis since the terrorist attacks of 2001," Secretary Thompson said. "These new grants add to this effort and will not only better prepare us for a

bioterrorism attack, but will also enhance our ability to deal with any public health crisis, such as SARS and West Nile virus." View Article

National Cholesterol Education Month
September - High blood cholesterol is a major risk factor for heart disease, the leading cause of death in the United States. It is estimated that 105 million American adults have total blood cholesterol levels of 200 milligrams per deciliter (mg/dL) and higher, which is above desirable levels. Of these, an estimated 42 million persons have levels of 240 mg/dL or above, which is considered high risk. To increase awareness of the importance of monitoring cholesterol levels and taking steps to achieve or maintain healthy levels, the National Cholesterol Education Program (NCEP) sponsors National Cholesterol Education Month every September. The NCEP recommends that adults aged 20 years or older have their cholesterol checked once every 5 years. View Article Cholesterol Fact Sheet

Officials Discover Leaking Mustard Gas at Deseret Chemical Depot
03 September – Global Security Newswire reported authorities discovered mustard gas leaking from seven projectiles at the Deseret Chemical Depot in Utah, the Tooele Transcript Bulletin reported. Workers found the leaking munitions Aug. 27, sealed them in larger containers and decontaminated the unit. Another leaking projectile was found two days earlier in the same storage area, according to the Transcript Bulletin. More than a cup of mustard agent leaked from the munitions before the problem was discovered. View Article

Pace of West Nile Cases Slows, But Deaths Rise
04 September – CIDRAP News reported the number of new West Nile virus infection cases decreased in the past week compared with the previous week, but the number of deaths rose, according to the Centers for Disease Control and Prevention (CDC). The CDC reports 414 new cases in 22 states in the week of Aug 28 through Sep 3, down from 727 cases in 26 states in the previous week. But 16 deaths were reported, compared with 7 the previous week, according to the CDC figures. The new cases brought the total number of West Nile cases to 1,856 for the year, with 37 deaths, the CDC reports in the Sep 5 issue of Morbidity and Mortality Weekly Report. View Article

Project Bioshield Could Allow Withholding Drug Information From Military Personnel
05 September – Global Security Newswire reported Congressional leaders may soon address a proposed law that critics say would reduce the U.S. military’s obligation to inform soldiers about the health risks of unlicensed biological defense drugs and vaccines they might be required to receive in an emergency. The provision, contained in the House version of the Project Bioshield Act of 2003, would allow officials to respond to some emergencies by administering drugs to the nation that have not been approved by the Food and Drug Administration. The law would require officials to inform potential drug recipients of the drug’s potential health risks and to get the recipients’ consent to administer the drug, but it would also permit the president and other senior officials to waive these requirements when delivering the drugs to U.S. military personnel. View Article

Serious Pneumonia Source Found in 4 U.S. Troops
05 September – CNN reported Army officials investigating a number of serious pneumonia cases among troops in the Iraq and Afghanistan campaigns say they have discovered what sickened four

soldiers. The Army's surgeon general's office said that medical teams had determined four of the 19 illnesses were caused by bacteria and that the patients recovered. Blood tests also showed that 10 of the 19 had larger than normal numbers of eosinophilia -- white blood cells known to fight certain infections, especially parasitic ones. Officials are continuing to study why this occurred. The Army investigation, in collaboration with the Centers for Disease Control and Prevention, is trying to determine if there are common factors among the cases. Officials said there is no evidence the cases were caused by exposure to chemical or biological weapons, environmental toxins or Sever Acute Respiratory Syndrome (SARS). View Article

Survey Finds Millions of New U.S. Drug Abusers
05 September – Reuters reported a redesigned survey of who uses and abuses drugs in the United States has found millions of "missed" users and addicts, with an estimated 22 million Americans suffering from alcohol or drug abuse. The study, released by the Substance Abuse and Mental Health Services Administration last week, finds that 19.5 million Americans used illicit drugs in 2002. This works out to 8.3 percent of the population age 12 or older. View Article

US to Miss Key Deadline for Chemical Weapons Destruction
04 September – Space War reported the United States acknowledged it will an important international deadline for destroying its arsenal of chemical weapons. The US Defense Department said in a statement it will not to able to liquidate 45 percent of its chemical stockpile by April 29, 2004, as required by the 1997 Chemical Weapons Convention. ‘The United States is therefore requesting the Organization for the Prohibition of Chemical Weapons (OPCW) grant an extension of the 45 percent destruction deadline,’ the statement said. The military is now expected to reach the elusive milestone by December 2007, the Pentagon said. View Article

Va. Reports La Crosse Encephalitis Cases
08 September – ABC News reported two children in Virginia have been diagnosed with La Crosse encephalitis, a rare mosquito-borne disease similar to West Nile virus. One case involves a child under 15 from Augusta County, the other a child from Tazewell County. State health officials declined to release any other details. Unlike West Nile, which is more common in older people, La Crosse cases are seen predominantly in children under 16. The diseases share similar symptoms: headaches, fever, neck stiffness and confusion. But West Nile, in the elderly, spreads to the nervous system and bloodstream, making it potentially fatal. Adults and children may not have any symptoms. Doug Larsen, health director for Central Shenandoah Health District, said the victim from the Churchville area of Tazewell County contracted the disease while in West Virginia. View Article

West Nile Virus in the U.S. as of 9 September, 2003

*Currently, WNV maps are updated each weekday to reflect surveillance reports released by state and local health departments to the CDC Arbonet system for public distribution. Map shows the distribution of avian, animal, or mosquito infection during 2003 with number of human cases if any, by state. If West Nile virus infection is reported to CDC Arbonet in any area of a state, that entire state is shaded accordingly. View Source

USPACOM
Bhutan: Conjunctivitis Outbreak in Phuentsholing
08 September – ProMed reported students are the worst affected by the conjunctivitis or 'red eye' infection which broke out in Phuentsholing a few weeks ago. Since the outbreak, the Phuentsholing Hospital has treated more than 800 infections of which 50 percent were students. The infection is highly contagious and spreads easily from close contact. Many others are being treated in private clinics in the neighboring Indian town of Jaigaon. Dr. A. Mukherjee of the Phuentsholing General Hospital stated that such viral or bacterial infection was seasonal and mostly surfaced during the monsoon season. "But this year we have seen the largest number of infections." While the infection was self-limiting and usually cured within a week Dr. Mukherjee said that proper preventive measures should be taken to prevent the infection from getting worse [and developing into] corneal ulceration or chronic conjunctivitis. He added that the infection in Phuentsholing was bacterial. View Report

China Starts SARS Surveillance Program Before Flu Season Starts
04 September – Bloomberg reported China's health ministry is stepping up surveillance for SARS before the winter flu season, which may mark a return of the deadly respiratory disease, the World

Health Organization's Beijing spokeswoman Maria Cheng said. Starting next week, hospitals in the southern province of Guangdong, the northwestern province of Shanxi and in the capital, Beijing, will start collating the past two years' records to determine how many cases of flu and pneumonia they treated. The three areas had the most cases of SARS in China. View Article

Dengue and Other Mosquito-Borne Diseases Continue to Plague Asia
03 September – VOA News reported it is rainy season in Southeast Asia, and the region is facing its annual battle with dengue fever and other mosquito-borne diseases. The World Health Organization says such diseases are a leading cause of hospitalization in several Asian nations. Dengue is found predominantly in urban areas, where mosquitoes breed in man-made containers that collect rainwater. Dengue, malaria and other parasitic and so-called vector-borne diseases are considered major health problems. The World Health Organization says about 2.5 billion people in the Americas, the Asia-Pacific region, Africa, and the Eastern Mediterranean are at risk of infection. View Article

Eight Die after Eating Poisoned Rice in China, 400 Others Poisoned
04 September – Yahoo News reported eight herdsmen died after eating poisoned rice in northwestern China, while more than 400 students were poisoned in two other incidents around the country. Three herdsmen in Qinghai province's Qumalai county died on Monday after eating the rice and five more died on Tuesday, the Xinhua news agency said. Another herdsman was recovering in hospital. Local officials confirmed the rice was the cause of the deaths and said the retailer who had sold it to them had been arrested. Food poisoning cases are an increasingly regular occurrence in China mainly due to insufficient government monitoring of the food service industry and poor hygiene practices. View Article

Hong Kong: DH Confirms New Cases of Cholera
08 September – ProMed reported the Department of Health (DH) on 1 Sep 2003 and 5 Sep 2003 called on members of the public to be on guard against food-borne infections following the confirmation of cholera cases in Hong Kong. One case involved a 19-year-old female who suffered from diarrhea and mild abdominal pain on 23 Aug 2003. She sought medical treatment in Tseung Kwan O Hospital on the following day. Her stool specimen yielded positive result for cholera and the strain type was identified as Ogawa. The second case involved a 25-year-old man who suffered from diarrhea on 21 Aug 2003. He sought medical treatment at a government clinic on 26 Aug. His stool specimen yielded positive result for cholera. Neither patient had traveled outside Hong Kong during the incubation period, and both cases were classified as local. DH and FEHD are investigating the source of the infections. These are the 5th and 6th cholera cases in Hong Kong so far in 2003, and all the cases are local ones. In 2002, there were 4 cholera cases, of which 2 were imported. View Report

Singapore: Patient at SGH Tests Positive for SARS Virus
08 September – ProMed reported a patient at the Singapore General Hospital tested positive for the SARS virus, triggering concern that the respiratory disease may have resurfaced here. More tests were done on the Singaporean man to confirm if the preliminary test result was correct, or if it was a false positive. He worked in a virology laboratory at Kent Ridge, but apparently was not working with the SARS virus. The man was sent to Tan Tock Seng Hospital on Monday. The SGH has started tracing everyone who may have been in contact with him, including those who were at the accident and emergency department when he went there last week with a fever. It is believed that the man, who has not been to China or Hong Kong recently, was at the A&E [emergency] department for 2 hours. View Report

Taiwan - First Local Transmission of Malaria in 38 Years
09 September – ProMed reported the Center of Disease Control (CDC) of Taipei said yesterday that tests had confirmed that a man in Taitung has malaria. The Taipei CDC is concerned that malaria may continue to spread, since the infected man has not traveled abroad. The The CDC is concerned that, according to World Health Organization standards, it is the first case of the disease contracted locally. According to officials, since the WHO declared Taiwan malaria-free in 1965, Taiwan has continued to see isolated cases of malaria each year. 19 cases have been reported so far in 2003. 18 of these were result of people being infected abroad, while the most recent case was contracted in Taiwan. The CDC stated that of the roughly 17 types of mosquitoes in Taiwan, only the Anopheles minimus spreads the disease. These mosquitoes inhabit Pingtung, Tainan, Taitung, Hualien, and Kaohsiung counties. View Report

Typhoon Dujuan leaves at least 32 dead, five missing in South China
03 September – Relief Web reported Typhoon Dujuan left at least 32 people dead, five missing and more than 100 injured as it swept through southern China, state media said. The typhoon caused widespread destruction in Guangdong province's Shenzhen city, which borders Hong Kong, killing 20 and injuring 98 people, 20 seriously. The casualty toll was the highest in the city from a typhoon since 1979, the agency said. At least five people were still missing after the typhoon struck Guangdong late Tuesday evening, other reports said. The dead included 16 construction workers killed by a collapsing building in Shenzhen. Emergency workers were mobilized to care for more than 10,000 Shenzhen residents, migrant workers and travelers who were evacuated or stranded by the typhoon. View Article

WHO Intensifies Efforts to Eradicate Polio
02 September – VOA News reported the World Health Organization is intensifying efforts to eliminate polio from four countries - India, Nigeria, Pakistan and Egypt. The efforts are most intense in India, which accounted for the majority of new cases last year. An unexpected outbreak of 1,600 new cases in Uttar Pradesh last year caught health authorities by surprise. It raised fears that the disease could spill into regions where polio has been stamped out. Worried health officials say the disease resurfaced because millions of children in Uttar Pradesh apparently had never been immunized. View Article

USSOUTHCOM
Bermuda Cleans Up after Strongest Hurricane in 50 Years
07 September – VOA News reported Bermuda residents have begun to clean up after the strongest hurricane to hit the islands in 50 years caused widespread damage and left four people missing. Authorities say many roads are blocked by debris and thousands of people have no electricity. Officials in the British colony said rescue workers were searching for two civilians and two police officers who were reported missing and feared dead. Their vehicles were swept off a causeway connecting Bermuda's main island to the airport. Hurricane Fabian struck the Atlantic archipelago with sustained winds of 185 kilometers per hour and gusts of more than 200 kilometers per hour. View Article

Venezuela - Yellow fever
06 September – ProMed reported the director of health of the state of Zulia, Luis Felipe De los Rios, stated that in the Zuliana region 38 patients have been registered under suspicion of yellow fever. Of these 18 patients died, 13 of them with a confirmed diagnosis of yellow fever. He also said that most cases are found concentrated on the Sierra de Perija, near the Colombia border, in particular around the Sur del Lago area, where a system of surveillance and vaccination is being implemented. The disease, which has not been detected in urban areas, may have originated in neighboring Colombia, Dr De los Rios said. View Report

Please contact the below-listed POC for suggested improvements and/or comments regarding this report. This report is also available on the USACHPPM website at http://chppmwww.apgea.army.mil/Hioupdate/. POC: Rachel Gross, PhD Rachel.Gross@APG.amedd.army.mil Lorraine Bell, DrPH, MSN Lorraine.Bell@APG.amedd.army.mil Approved: Kevin Delaney Chief, Health Information Operations (410) 436-5217 or DSN 584-5217